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ACTION: CODED BY: DATE: GROUP MEDICAL and

ACTION: CODED BY: DATE: GROUP MEDICAL and 2026

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The document is an application form for group medical and dental insurance for United Nations staff members. It outlines the necessary information required from applicants, including personal details, employment status, and coverage options. The form also provides instructions on how to submit the application and details about eligibility, changes in coverage, and requirements for dependents. Key points include deadlines for enrollment and conditions under which dependents can be added or removed.

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Click ‘Get Form’ to open it in the editor.
Begin by selecting your employment status under 'EMPLOYED BY'. Choose from options like UN Secretariat, UNICEF, or specify another organization.
Fill in your personal details including Last Name, First Name, Date of Birth, and Sex. Ensure accuracy as this information is crucial for your insurance records.
Provide your Mailing Address. Remember to register this address with your Human Resources Office to receive important communications.
Indicate your Office Room Number and Telephone Number for contact purposes.
Select the Type of Contract you hold and provide the relevant dates if applicable.
Complete sections regarding Life Insurance preferences and Medical Coverage selections by checking appropriate boxes.
List any dependents under the specified sections, ensuring all necessary details are filled out accurately.
Review all entries for correctness before signing and dating the form at the bottom.

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Which activity should be included in the total time spent by physicians or other QHPs according to AMA guidelines?

Time includes all activities (both face-to-face and non-face-to-face) related to the encounter performed by the physician or QHP on the date of the encounter. This includes activities such as reviewing external notes/tests/etc.

What are the three accident occurrence codes?

Occurrence Code is a two-digit alphanumeric code used on claims to provide additional information about specific events related to a patients care. Occurrence Code A1 Birth Date. Occurrence Code 01 Accident/Medical Coverage. Occurrence Code 03 Accident/Tort Liability. Occurrence Code 04 Accident/Employment Related.

What are group codes in medical billing?

Group Codes assign financial responsibility for the unpaid portion of the claim balance e.g., CO (Contractual Obligation) assigns responsibility to the provider and PR (Patient Responsibility) assigns responsibility to the patient. Medicare beneficiaries may be billed only when Group Code PR is used with an adjustment.

What is the group code in insurance?

The Group Code is combined with the ANSI reason code to demonstrate who has financial responsibility for the amount. PR - Patient Responsibility This shows what amount the beneficiary or his/her supplemental insurer is responsible for.

Can you code from past medical history?

Conditions should not be coded that were previously treated or no longer exist. However, history codes may be used as secondary codes if the historical condition or family history has an impact on current care or influences treatment.

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What does group code OA mean?

OA (Other Adjustments) is used when CO (Contractual Obligation) nor PR (Patient Responsibility apply. This can be used when the claim is paid in full and there is no contractual obligation or patient responsibility on the claim.

What are the EOB group codes?

The five EOB Claim Adjustment Group Codes are Contractual Obligation (CO), Corrections and Reversal (CR), Other Adjustment (OA), Payer Initiated Reductions (PI), and Patient Responsibility (PR).

ACTION: CODED BY: DATE: GROUP MEDICAL and 2026

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